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Our sorry state

Monday, Apr 19, 2021

* The 2019 budget implementation bill is preventing thousands of autistic kids from getting therapy. Here’s Megan Valley and Raymon Troncoso from the Belleville News-Democrat

(D)espite a 2014 federal mandate that states cover autism treatment through Medicaid, Illinois was one of a handful of states that didn’t provide Medicaid coverage for behavioral therapy until 2019.

However, an error in implementation created restrictions on who could provide behavioral therapy, an obstacle that has functionally prevented Illinois’ Medicaid plan from covering behavioral therapy despite it technically being included in Medicaid spending on paper. […]

A notice from the Illinois Department of Healthcare and Family Services released in October confirmed that dual credentials would be required to receive Medicaid funds through the department for behavioral therapy.

But the Illinois Autism Task Force, based in the Illinois Department of Human Services, warned in a February letter to Gov. JB Pritzker and the General Assembly that “the dual credential requirement will result in devastating barriers to access.” That same letter said only 26 BCBAs possessed one of the other required certifications and it was unclear whether any of the 26 provided behavioral therapy.

The Autism Task Force, in a 2020 meeting, claimed that $42 million placed in the state’s FY 2020 budget for behavioral therapy through Medicaid remained untouched due to the mistake.

Paul estimated there are about 3,500 ASD-diagnosed children under age 5 who are covered by Medicaid in Illinois.

The letter is here.

- Posted by Rich Miller        

6 Comments
  1. - west wing - Monday, Apr 19, 21 @ 11:07 am:

    more tough news for these kids and their families… sorry to see this


  2. - DuPage Dave - Monday, Apr 19, 21 @ 11:23 am:

    Medicaid plan changes typically take a long time to make, so good luck to all involved. This seems to be another negative effect of the push to have certifications and credentials for every possible human service provider. If you end up with only 26 qualfied providers in the state, you haven’t thought things through carefully.


  3. - ELP - Monday, Apr 19, 21 @ 11:57 am:

    HB16 would go along way to correct half of the problem. It would expand those who can provide the service and create much greater coverage across the state. The real problem, is the low rate of reimbursement offered through Medicaid for the service. Even if more providers become eligible, no one will provide the service because the rate of reimbursement is below their actual costs. Really need to expand those who can provide the service AND increase the reimbursement rate.


  4. - JS Mill - Monday, Apr 19, 21 @ 12:23 pm:

    The state of behavioral health care is abysmal. It is a national embarassment.


  5. - thisjustinagain - Monday, Apr 19, 21 @ 1:09 pm:

    Personally familiar with Medicaid’s failures, so this is no surprise that despite the legal duty to provide care, DHS/HFS find a new way to deny it. Wait for the lawsuit to follow, then the fumble of obeying the Court’s orders, etc.
    But the low reimbursement rates don’t help matters either; my primary doc stopped taking Medicaid years ago because the hassle wasn’t worth what he was paid for services. Only someone who can more or less afford to give away services will take Medicaid by itself (some dual-eligible patients get Medicaid and Medicare, so docs will take them).


  6. - Anonymous - Thursday, Apr 22, 21 @ 4:13 pm:

    What’s a bigger embarrassment is the age cap on autism services so that I as an autistic can’t get help to be a productive member of my community.


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